| 1. The Government’s
vision is a National Health Service for the
people of Scotland that offers them the treatment
they need, where they want it, and when: a
modern, “designed” health service
putting patients first. We want a seamless health
service centred on primary care, designed to
ensure that patients receive care quickly and
with certainty. This White Paper sets out how we
will achieve these objectives. 2. The Government will ensure that
the NHS remains true to its historic ideals, free
at the point of use, funded through general
taxation and available to all on the basis of
need. This Government were elected with a clear
mandate for change - a mandate to change the NHS
for the better. We will deliver the commitments
which won us the support of the Scottish people,
and do so in ways which recognise the distinctive
needs of Scotland. These have been long reflected
in the structure and organisation of our health
services, and we shall build on them. To do so is
entirely in keeping with the traditions of the
past, but also acknowledges that the creation of
a Scottish Parliament is intended to ensure that
in the future Scottish solutions are found to
suit Scottish circumstances.
3. The NHS has stood the
test of time for 50 years. In designing our
proposals to renew and modernise the NHS in
Scotland, the Government intend to lay the
foundations for a service which is fit for the
next 50 years. The speed of change in scientific
knowledge and medical technologies, and the
potential offered by modern information and
communication systems require the NHS to be ready
to embrace change. Instead of lurching from one
major reorganisation to another, we need to
embrace evolutionary changes, paced and
researched, building on what we have.
4. It is sometimes argued
that the NHS cannot cope with the pressures it
now faces and the challenge posed by the pace of
change. The Government reject that view. We will
enable the NHS in Scotland to meet the pressures
of the future and continue to provide a
comprehensive range and quality of health care
services through our commitment to annual real
increases in resources for the NHS in Scotland,
together with its capacity to find newer and more
efficient ways of delivering services. In
addition, the NHS in Scotland is well-equipped to
make medical decisions based on patient need. Our
medical culture is based on clinical judgements
in which we distinguish between competing demands
on the basis of need. As a result, we have a
system which reduces unnecessary investigation
and treatment. The Government are committed to
enhancing this culture. We must root out
inefficient and ineffective clinical procedures,
subject new drugs and therapies to painstaking
analysis in terms of their clinical and
cost-effectiveness, eliminate inefficiencies that
result from bureaucracy and address the
differences in the availability of health care
which re-inforce inequalities.
5. Our vision is to build
on the strengths we have in the NHS in Scotland
and to tackle some of the existing shortcomings
which are of concern to patients and NHS staff
alike. We want an NHS concentrated on improving
health and reducing health inequalities. Scotland
is at, or close to the bottom of, the
international health league table in the key
areas of coronary heart disease and cancer, and
people in other European nations enjoy a
significantly longer life expectancy than the
people of Scotland. While the NHS must continue
to target these key areas, real improvements in
public health will only be effected by tackling
the variations in health status between social
groups and between different parts of Scotland.
We will publish a Green Paper aimed at
establishing a collaborative approach between the
NHS and the agencies whose decisions on housing,
unemployment and poverty directly affect
Scotland’s health.
6. We want a service which
is designed from the patient’s viewpoint,
which delivers clinically-effective care and
which does so quickly and reliably in
high-quality facilities. We want a world class
health service, available throughout Scotland
when people need it. In our renewed NHS, a wider
range of information on health, health services
and treatment will be available to patients. They
will have local access to teams of health care
professionals working together, able to obtain
specialist expertise when needed, because family
doctors and hospital staff are part of a network
of integrated clinical services which deliver
seamless care.
7. We believe our vision is
shared by staff in the NHS in Scotland. We intend
to create a health service where staff are free
to concentrate on the task to which they are most
committed - the delivery of high quality care.
8. To deliver this vision,
the Government have concluded that a partnership
approach based on co-operation, not competition,
is the way ahead for Scotland’s Health
Service. A market-style NHS has failed patients;
it set doctor against doctor, and developed
two-tierism allied to bureaucracy, although to a
lesser extent in Scotland than elsewhere. We will
retain the benefits of devolved management and
retain distinctive roles for Health Boards and
Trusts in a patient-focused service built on
partnership. Our approach will bring people
together to meet the needs of patients by
developing 4 main partnerships:
- a partnership between
the Government and the people of
Scotland, reflected in the
Government’s pledge to continue with
annual real increases in NHS funding;
- a partnership between
patients and the professionals who care
for them, by giving both a bigger say in
the design and management of the NHS in
Scotland;
- a partnership between
different parts of the NHS in Scotland to
promote the integration of care and
provide patients with a seamless service;
- a partnership between
the NHS in Scotland and other
organisations whose work can help improve
health and the quality of services to
patients.
9. There have always been
differences in the way the NHS is organised in
the different parts of the UK to take account of
different needs. But sometimes, changes have been
made in Scotland to reflect changes in England
rather than in response to specifically Scottish
needs. The NHS will continue to provide a common
service throughout the United Kingdom, but the
advent of the Scottish Parliament will mean a
Scottish NHS more finely tuned and more rapidly
responsive to Scottish needs.
10. The NHS in Scotland
will be one of the main responsibilities of the
Scottish Parliament. It will be for the Scottish
Parliament to decide the details of its
relationship with health bodies, including
funding arrangements. Devolution provides an
opportunity to build on the strengths of the NHS
in Scotland, as well as on the Scottish tradition
of community responsibility for those needing
care. For example, services can be organised to
take account of the range of differing needs,
from those of major cities to those of remote and
island communities. The new system outlined in
this White Paper lays the foundations for the
work of the Scottish Parliament in improving the
health of the Scottish people now and for future
generations.
11. The Government believe
the proposals in the White Paper will result in
an NHS in Scotland designed to put patients
first, better equipped to take advantage of new
technology to improve clinical effectiveness and
the reliability of clinical care, and better able
to develop distinctive solutions to
Scotland’s health needs and to provide
better value for money. It will keep faith with
its founding ideals by delivering comprehensive
services to promote good health, rapid diagnosis
and treatment for those who are ill, and care for
those with continuing needs, and it will be
funded through general taxation so that nobody
need worry about the cost of being ill.
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